Friday, 21 December 2018 18:50

Anticoagulation news items. Week commencing 17th December 2018

Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis

British Medical Journal

Review of 3 RCTs (n=10,447) found that compared with aspirin alone clopidogrel plus aspirin, started within 24 hours of symptom onset, reduced the risk of non-fatal recurrent stroke (RR 0.70, 95% CI 0.61-0.80, absolute risk reduction 1.9%).

 

Graduated compression stockings for prevention of deep vein thrombosis

Cochrane Database of Systematic Reviews

Review of data from 20 high-quality RCTs (n=1681) concludes graduated compression stockings are effective in reducing the risk of DVT in hospitalised patients who have undergone general and orthopaedic surgery, with or without other methods of background thromboprophylaxis.

 

Rutosides for treatment of post‐thrombotic syndrome

Cochrane Database of Systematic Reviews

Review of 3 low quality RCTs (n=233) concludes rutosides are not superior to placebo or elastic compression stockings for post‐thrombotic syndrome, characterised by pain, swelling, and skin changes in affected limb. Rutosides are a group of compounds derived from horse chestnut.

 

NIHR Signal: The best dose of aspirin for cardiovascular protection may depend on body weight

National Institute for Health Research Signal

Expert commentary is provided for a review of 13 RCTs which found that low dose aspirin was effective for secondary prevention in those <70kg, but not >70kg. The findings reinforce the importance of tailoring the aspirin dose to a patient's characteristics, including weight.

 

Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials

European Heart Journal

Analysis of 11 trials (n=157,248) found at mean follow-up of 6.6 years, aspirin was not linked to lower incidence of all-cause mortality but to increased incidence of major bleeding (RR 1.47, 95% CI 1.31–1.65; p< 0.0001) and intracranial haemorrhage (1.33, 1.13–1.58; p = 0.001).

 

Janssen submits supplemental new drug application to US FDA for rivaroxaban to prevent venous thromboembolism in acute medically ill patients

Biospace Inc.

Application is based on data from phase 3 MAGELLAN and MARINER trials. MAGELLAN met its co-primary endpoints, demonstrating non-inferiority to enoxaparin in short-term (10 days) and superiority in long-term (35 days) use, while MARINER demonstrated reduction in symptomatic VTE.

 

Effectiveness and safety of 110 or 150 mg dabigatran vs. vitamin K antagonists in nonvalvular atrial fibrillation

British Journal of Clinical Pharmacology

French new-users cohort study (n=14,442) reported that dabigatran at either dose was associated with less major bleeding, stroke and systemic embolism and all-cause mortality than matched VKA-treated patients.

 

Effectiveness and safety of apixaban versus rivaroxaban for prevention of recurrent venous thromboembolism and adverse bleeding events in patients with venous thromboembolism: a retrospective population-based cohort analysis

The Lancet

US database study (3091 apixaban users and 12,163 rivaroxaban users) reported that use of apixaban vs rivaroxaban was associated with decreased risk of recurrent VTE (HR 0.37; 95% CI 0.24–0.55]; p<0.0001) and major bleeding events (0.54; 0.37–0.82; p=0.0031).

 

MI risk associated with naproxen and diclofenac in spondyloarthritis: DTB Select summary

Drug and Therapeutics Bulletin

Summary and context is provided for analysis of the incidence of myocardial infarction in people with spondylarthritis and osteoarthritis treated with NSAIDs which provides further evidence that diclofenac is associated with a higher risk than naproxen.

 

Comparative safety and effectiveness of direct oral anticoagulants in patients with atrial fibrillation in clinical practice in Scotland

British Journal of Clinical Pharmacology

Retrospective cohort study (n=14,577) found all DOACs were similarly effective in preventing stroke, systemic embolism or CV death, while patients on rivaroxaban showed highest bleeding risks.Observed differences in risks of all‐cause mortality, MI and PE warrant further research.

 

 

The above records have been identified by UKMi and feature in the NICE Medicines Awareness Service. Further details on this service can be found at:

http://www.evidence.nhs.uk/about-evidence-services/content-and-sources/medicines-information/new-medicines-awareness-services